Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study

Lebwohl, Benjamin; Larsson, Emma; Söderling, Jonas; Roelstraete, Björn; Murray, Joseph A.; Green, Peter H. R.; Ludvigsson, Jonas F.

doi:10.2147/clep.s294391

Cited by 29 publications

(41 citation statements)

References 33 publications

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“…[7][8][9] A recent population-based study of CD patients in Sweden found no increased risk of COVID-19-related outcomes among people with CD. 10 To our knowledge, this is the first study evaluating predictors of severe of COVID-19 outcomes among patients with CD. Strengths include its international nature and reliance on clinician reporting, likely enhancing the veracity of both CD and COVID-19 diagnoses.…”

Section: Discussionmentioning

confidence: 95%

An International Reporting Registry of Patients With Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC

Uche-Anya

Husby

Kaplan

et al. 2021

Clinical Gastroenterology and Hepatology

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S urveillance Epidemiology Under Research Exclusion for Celiac Disease (SECURE-CELIAC) is an international, de-identified adult and pediatric database created to monitor and report on the severity of coronavirus disease 2019 (COVID-19) outcomes in patients with celiac disease (CD). MethodsThe SECURE-CELIAC registry (https://covidceliac. org/) was modeled on (and with support from) a comparable registry for patients with inflammatory bowel disease (https://covidibd.org/). It was established on March 31, 2020, and promoted via physician email lists, national societies, and social media. Clinicians worldwide were asked to report all confirmed cases of COVID-19 (through viral polymerase chain reaction swab or serology) in patients with CD using a secure online data entry platform. Clinicians were counseled to report cases only after a minimum of 7 days and resolution of illness or death. A choropleth map to illustrate geographic differences in reported cases of COVID-19 in those with CD was created using QGIS 3.44. An interactive online website was created using ArcGIS Online and ArcGIS Pro 2.4.1 to visualize current data by time, country, age, sex, hospitalizations, and deaths (https://arcg.is/1PyiXD). 1 This study was approved by the institutional review board at Columbia University Medical Center. Statistical analyses were conducted using SAS v9.4 (SAS Software, Cary, NC). We aimed to assess for CD-specific factors associated with severe COVID-19 outcomes, defined as hospitalization or death. Continuous and categorical variables were analyzed using the Mann-Whitney U test and the Fisher exact test, respectively. Multivariable analysis was performed using logistic regression.

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Section: Discussionmentioning

confidence: 95%

An International Reporting Registry of Patients With Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC

Uche-Anya

Husby

Kaplan

et al. 2021

Clinical Gastroenterology and Hepatology

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“…However, the comorbidities identified as a significant predictor of morbidity and mortality on COVID-19 were more frequent in CD individuals than control ones [ 22 ]. A cohort study conducted in Sweden with 40,963 CD individuals showed that they were neither at increased risk of hospitalization for COVID-19 than the control ones nor at high risk for severe disease outcomes and mortality [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, CD interferes in the patient’s daily life beyond the gastrointestinal and health aspects of the disease such as their social, economic, and emotional status [ 11 ]. While several studies have been carried out on the pandemic’s psychological effects on the general public, patients, medical staff, children, and elderly [ 5 , 12 , 13 , 14 ], and several other studies were performed on celiac individuals during the pandemic [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], none evaluated the QoL of CD patients during the difficult times of the pandemic. Therefore, the objective of this research was to evaluate Brazilian celiac patients’ QoL during the pandemic caused by the outbreak, rapid spread, and subsequent restrictive measures caused by COVID-19, in addition to the dietary restrictions and other burdens caused by CD.…”

Section: Introductionmentioning

confidence: 99%

Health-Related Quality of Life and Experiences of Brazilian Celiac Individuals over the Course of the Sars-Cov-2 Pandemic

et al. 2021

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Since the end of 2019, the world has been facing an unpredicted COVID-19 pandemic with consequences for the economy, environment, society, and health. The COVID-19 pandemic has increased the risk of death, bringing unbearable psychological pressure upon people worldwide. For celiac patients, the pandemic may represent an additional burden concerning the inherent aspects of celiac disease (CD) that compromise these individuals’ quality of life (QoL). Therefore, the objective of this study was to evaluate Brazilian celiac patients’ QoL during the course of the COVID-19 pandemic caused by its outbreak and rapid spread and subsequent restrictive measures in addition to the dietary restrictions and other burdens caused by CD. This country-wide cross-sectional study was conducted using a self-administered instrument previously validated in Brazilian–Portuguese to investigate the QoL of individuals with CD. Data collected through the online self-administration of the Brazilian version of the celiac disease quality of life questionnaire (CDQ) comprised 674 CD individuals’ responses. Although pandemics have historically posed a challenge for Brazilian population, this period was not associated with a negative impact on Brazilian CD individuals’ QoL. During the pandemic, the QoL of Brazilian’s with CD was more affected by gastrointestinal aspects than emotions and social aspects and worries. Gender, age, marital status, having (or not) children, occupation, and a positive test for COVID-19 did not affect CD individuals’ QoL. However, the study revealed a larger burden and diminished QoL for individuals not following a gluten-free diet and those using antidepressants. Additional research is necessary to verify how the length of the pandemic will affect celiac individuals and then compare those outcomes compare to the COVID-19 period and after.

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“…No significant alteration from general COVID-19 symptoms (Zingone et al, 2020;Gokden et al, 2020;Lebwohl et al, 2021) CHB, chronic hepatitis B; CHC, chronic hepatitis C; NAFLD, non-alcoholic fatty liver disease; HCC, hepatocellular carcinoma; IBD, irritable bowel disease; ACLF, acute-on-chronic liver failure; HIV, human immunodeficiency virus; TNF, tumor necrosis factor; GI, gastrointestinal.…”

Section: Cirrhosismentioning

confidence: 99%

“…In the current scenario, studies involving patient-response-based data collection and analysis have been done to determine the risk associated with CeD towards susceptibility and severity of COVID-19. A large CeD subset (n= 40,963) from nationwide histology-based population of patients with GI diseases in Sweden, ESPRESSO, was identified, and no significant increase in COVID-19-based hospitalizations, severity, or mortality was observed as compared to the control group (n= 183,892) ( Lebwohl et al., 2021 ). Another study from Italy, involving 171 CeD patients on gluten-free diet, also suggests no major association of CeD with increased risk of SARS-CoV2 infection or severity ( Zingone et al., 2020 ).…”

Section: Gi Diseasesmentioning

confidence: 99%

Host Response to SARS-CoV2 and Emerging Variants in Pre-Existing Liver and Gastrointestinal Diseases

Nayak

Lal

Kumar

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundNovel coronavirus SARS-CoV2 is evolving continuously with emergence of several variants of increasing transmission capabilities and pandemic potential. Generation of variants occurs through accumulation of mutations due to the RNA nature of viral genome, which is further enhanced by variable selection pressures of this ongoing pandemic. COVID-19 presentations of SARS-CoV2 are mainly pulmonary manifestations with or without mild gastrointestinal (GI) and hepatic symptoms. However, the virus has evolved beyond pulmonary manifestations to multisystem disorder due to systemic inflammation and cytokine storm. Definitive cause of acute or late onset of inflammation, infection in various organs, and host response to emerging variants lacks clarity and needs elucidation. Several studies have reported underlying diseases including diabetes, hypertension, obesity, cardio- and cerebrovascular disorders, and immunocompromised conditions as significant risk factors for severe form of COVID-19. Pre-existing liver and GI diseases are also highly predominant in the population, which can alter COVID-19 outcome due to altered immune status and host response. We aim to review the emerging variants of SARS-CoV2 and host response in patients with pre-existing liver and GI diseases.MethodsIn this review, we have elucidated the emergence and characteristic features of new SARS-CoV2 variants, mechanisms of infection and host immune response, GI and hepatic manifestation with radiologic features of COVID-19, and outcomes in pre-existing liver and GI diseases.Key FindingsEmerging variants of concern (VOC) have shown increased transmissibility and virulence with severe COVID-19 presentation and mortality. There is a drastic swift of variants from the first wave to the next wave of infections with predominated major VOC including alpha (B.1.1.7, UK), beta (B.1.351, South Africa), gamma (B.1.1.28.1, Brazil), and delta (B1.1.617, India) variants. The mutations in the spike protein of VOC are implicated for increased receptor binding (N501Y, P681R) and immune escape (L452R, E484K/Q, T478K/R) to host response. Pre-existing liver and GI diseases not only have altered tissue expression and distribution of viral entry ACE2 receptor but also host protease TMPRSS2, which is required for both spike protein binding and cleavage to initiate infection. Altered immune status due to pre-existing conditions results in delayed virus clearance or prolonged viremia. Even though GI and hepatic manifestations of SARS-CoV2 are less severe, the detection of virus in patient’s stool indicates GI tropism, replication, and shedding from the GI tract. COVID-19-induced liver injury, acute hepatic decompensation, and incidences of acute-on-chronic liver failure may change the disease outcomes.ConclusionsThe changes in the spike protein of emerging variants, immunomodulation by viral proteins, and altered expression of host viral entry receptor in pre-existing diseases are the key determinants of host response to SARS-CoV2 and its disease outcome.

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Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study

Cited by 29 publications

References 33 publications

An International Reporting Registry of Patients With Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC

An International Reporting Registry of Patients With Celiac Disease and COVID-19: Initial Results From SECURE-CELIAC

Health-Related Quality of Life and Experiences of Brazilian Celiac Individuals over the Course of the Sars-Cov-2 Pandemic

Host Response to SARS-CoV2 and Emerging Variants in Pre-Existing Liver and Gastrointestinal Diseases

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